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International Orthopaedics

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01-03-2021 | Original Paper

Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up

Authors: Stanislas Gunst, Lucie Louboutin, John Swan, Sebastien Lustig, Elvire Servien, Laurent Nove-Josserand

Published in: International Orthopaedics | Issue 3/2021

Abstract

Purpose

Reverse shoulder arthroplasty (RSA) is often indicated in elderly patients with displaced proximal humerus fractures (PHF). The rate of greater tuberosity (GT) healing varies from 37 to 90% in this population. The aim of this study was to assess greater and lesser tuberosity (LT) fixation and healing on CT scan after RSA for PHF. Our hypothesis was that both GT and LT healing leads to better functional results after RSA for fracture.

Methods

Our retrospective cohort consisted of 28 patients treated with an RSA for a four-part PHF during the inclusion period. The mean age at surgery was 77 years. Clinical examination and CT scan were performed at a minimum one year follow-up to assess tuberosity position and healing.

Results

The GT healed in 22 patients (78.5%), the LT in 24 patients (87.5%) and both tuberosities were healed in 20 patients (71.5%). Constant score was significantly improved with GT, LT and both tuberosity healing (p = 0.05, p = 0.04 and p = 0.02 respectively). Motion in anterior elevation was improved with GT and both tuberosity healing (p = 0.01 and p = 0.04 respectively). Motion in external rotation was improved with GT and both tuberosity healing (p = 0.01 and p = 0.02 respectively).

Conclusion

GT and LT healing was associated with better functional results and active motion. Anatomical reduction and consolidation of both tuberosities is beneficial with a cumulative effect for functional recovery.

Obert L, Saadnia R, Tournier C et al (2016) Four-part fractures treated with a reversed total shoulder prosthesis: prospective and retrospective multicenter study. Results and complications. Orthop Traumatol Surg Res 102:279–285. https://doi.org/10.1016/j.otsr.2016.01.019CrossRefPubMed

Jorge-Mora A, Amhaz-Escanlar S, Fernández-Pose S et al (2019) Early outcomes of locked noncemented stems for the management of proximal humeral fractures: a comparative study. J Shoulder Elbow Surg 28:48–55. https://doi.org/10.1016/j.jse.2018.05.036CrossRefPubMed

Cazeneuve JF, Cristofari D-J (2009) Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 95:325–329. https://doi.org/10.1016/j.otsr.2009.03.018CrossRefPubMed

Gallinet D, Clappaz P, Garbuio P et al (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95:48–55. https://doi.org/10.1016/j.otsr.2008.09.002CrossRefPubMed

Gallinet D, Adam A, Gasse N et al (2013) Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Shoulder Elbow Surg 22:38–44. https://doi.org/10.1016/j.jse.2012.03.011CrossRefPubMed

Garofalo R, Flanagin B, Castagna A et al (2015) Reverse shoulder arthroplasty for proximal humerus fracture using a dedicated stem: radiological outcomes at a minimum 2 years of follow-up-case series. J Orthop Surg Res 10:129. https://doi.org/10.1186/s13018-015-0261-1CrossRefPubMedPubMedCentral

Grubhofer F, Wieser K, Meyer DC et al (2016) Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg 25:1690–1698. https://doi.org/10.1016/j.jse.2016.02.024CrossRefPubMed

Boileau P, Alta TD, Decroocq L et al (2019) Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities? J Shoulder Elbow Surg 28:437–444. https://doi.org/10.1016/j.jse.2018.08.025CrossRefPubMed

Jain NP, Mannan SS, Dharmarajan R, Rangan A (2018) Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.09.006

10.

Schmalzl J, Jessen M, Sadler N et al (2020) High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis. BMC Musculoskelet Disord 21:35–38. https://doi.org/10.1186/s12891-020-3060-8CrossRefPubMedPubMedCentral

11.

Gallinet D, Cazeneuve JF, Boyer E et al (2019) Reverse shoulder arthroplasty for recent proximal humerus fractures: outcomes in 422 cases. Orthop Traumatol Surg Res 105:805–811. https://doi.org/10.1016/j.otsr.2019.03.019CrossRefPubMed

12.

Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 89:516–520. https://doi.org/10.1302/0301-620X.89B4.18435CrossRefPubMed

13.

Chun Y-M, Kim D-S, Lee D-H, Shin S-J (2017) Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes? J Shoulder Elbow Surg 26:1216–1221. https://doi.org/10.1016/j.jse.2016.11.034CrossRefPubMed

14.

Uzer G, Yildiz F, Batar S et al (2017) Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty? J Shoulder Elbow Surg 26:36–41. https://doi.org/10.1016/j.jse.2016.05.005CrossRefPubMed

15.

Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am 95:2050–2055. https://doi.org/10.2106/JBJS.L.01637CrossRefPubMed

16.

Torrens C, Alentorn-Geli E, Mingo F et al (2018) Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: influence of greater tuberosity healing on the functional outcomes. J Orthop Surg (Hong Kong) 26:230949901876013–230949901876017. https://doi.org/10.1177/2309499018760132CrossRef

17.

Marcheix P-S, Bazin I, Vergnenegre G et al (2020) Treatment of cephalotuberosity fractures in elderly patients treated by reverse shoulder prosthesis: a study of functional results in relation to deltoid tension. Int Orthop 44:147–154. https://doi.org/10.1007/s00264-019-04427-6CrossRefPubMed

18.

Ohl X, Bonnevialle N, Gallinet D et al (2018) How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 27:2139–2144. https://doi.org/10.1016/j.jse.2018.05.030CrossRefPubMed

19.

Boileau P, Winter M, Cikes A et al (2013) Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder Elbow Surg 22:1495–1506. https://doi.org/10.1016/j.jse.2013.04.018CrossRefPubMed

20.

Formaini NT, Everding NG, Levy JC, Rosas S (2015) Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique. J Shoulder Elbow Surg 24:e299–e306. https://doi.org/10.1016/j.jse.2015.04.014CrossRefPubMed

21.

Sirveaux F, Roche O, Molé D (2010) Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 96:683–694. https://doi.org/10.1016/j.otsr.2010.07.001CrossRefPubMed

22.

Werthel J-D, Sirveaux F, Block D (2018) Reverse shoulder arthroplasty in recent proximal humerus fractures. Orthop Traumatol Surg Res 104:779–785. https://doi.org/10.1016/j.otsr.2018.07.003CrossRefPubMed

23.

Wright JO, Ho A, Kalma J et al (2019) Uncemented reverse total shoulder arthroplasty as initial treatment for comminuted proximal humerus fractures. J Orthop Trauma 33:e263–e269. https://doi.org/10.1097/BOT.0000000000001465CrossRefPubMed

24.

Mark M, Jeremy M, Brandon S et al (2018) Thermal effects of impaction grafting in proximal humeral hemiarthroplasty. Orthopaedic Proceedings. https://doi.org/10.1302/1358-992X.95BSUPP_34.ISTA2013-427

25.

Singh A, Padilla M, Nyberg EM et al (2017) Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture. J Shoulder Elbow Surg 26:437–442. https://doi.org/10.1016/j.jse.2016.08.003CrossRefPubMed

Title: Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up
Authors: Stanislas Gunst
Lucie Louboutin
John Swan
Sebastien Lustig
Elvire Servien
Laurent Nove-Josserand
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 3/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04928-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Does healing of both greater and lesser tuberosities improve functional outcome after reverse shoulder arthroplasty for fracture? A retrospective study of twenty-eight cases with a computed tomography scan at a minimum of one-year follow-up

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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